Using Incentives for Improving Treatment Compliance in Adolescents - Literature review Example

Using Inсеntivеs for Improving Trеаtmеnt Соmрliаnсе in Аdоlеsсеnts with Сhrоniс Соnditiоns: А Review Student’s Name Institutional Affiliation Using Inсеntivеs for Improving Trеаtmеnt Соmрliаnсе in Аdоlеsсеnts with Сhrоniс Соnditiоns: А Review Introduction Chronicity is a terminology which many authors have struggled to explain over the last decades. The Commission on Chronic Illness is believed to be the first to address the definition of chronicity by identifying the characteristics of chronic illnesses. According to the Commission on Chronic Illness, the following are some of the characteristics of chronic diseases, namely: everlasting, disability, requires assessment, planning and management among others. Nolte & Mckee (2008) argued that chronic illnesses are complex and alter lifestyles, and therefore, they require individualized management. Other authors among them (Perez et al, 2010) and (Ardies, 2014) argue that people with chronic pain experience pain throughout their live. Thus, effective chronic pain management is dependent on the partnership between various stakeholders, including the patient, family members and the nursing staff. Combining the views of the above cited authors; chronicity can be defined as long term condition that requires daily management responsibilities from the patients, nurses and the family members. Effective chronic diseases management is the main objective of healthcare providers. Chronic conditions, including diabetes and asthma are becoming common life threatening diseases, in Australia. The Australian Institute of Health and Welfare (AIHW) gave a shocking report and statistics of the people affected with chronic illnesses, including Asthma, diabetes and cancer. According to AIHW, more than seven million of the Australian population had at least one life threatening condition by 2005. According to the report, adolescents are more prone to life threatening ailments due to their behaviors, such as alcohol misuse, unprotected sex, poor nutrition, tobacco smoking, excess body weight, high blood cholesterol among others. According to recent studies in Australia, the number of adolescents living with chronic illnesses is bound to increase in the next 10 years. Thus, an increase in chronic conditions in Australia will cause a major strain on the healthcare systems. Adolescents take a greater pie of the Australian population, and therefore, their health is important (ABS, 2014). The Australian government spends more than $35.6 billion per annum, on costs related to preventable adolescent health problems. The primary aim of any prescribed medication is to attain certain desired results in patients. Chronic disease management helps to increase the quality of life for the concerned patients. Thus, healthcare professionals are tasked with the role of ensuring that patients comply with the prescribed medications. Although medical professionals strive to ensure therapeutic compliance, some patients, especially adolescent patients, do not follow therapy instructions fully. This, therefore, hinders healthcare professionals from attaining desired outcomes. According to Crame (2008), treatment compliance refers to adherence to prescribed medications and other therapeutic aspects. Past research on treatment compliance in adolescents with life threatening illnesses shows that only 50% of adolescents comply with medical treatment (Taddeo, Egedy & Frappier, 2008). Some of the reasons for poor treatment compliance among adolescents with chronic diseases include low educational levels, negative attitudes towards therapies, racial discrimination, poverty, gender issues, lack of parental guidance and support among others. Adolescents living with chronic diseases are concerned about whether they will have enough money in the future to cater for their needs. In addition, they are uncomfortable with regular medical aid and assistance that becomes a routine in their lives. These persons are often faced with the problem of loneliness and sometimes feel that they are isolated from family members and friends. Therefore, it is necessary to provide adolescents with chronic illnesses some incentives in order to enhance their treatment compliance. For treatment to be effectively administered to adolescents with chronic conditions there should be some incentives, such as cash, tokens, and gifts. Usually, adolescents with chronic illnesses are highly unlikely to adhere to medications without rewards. This literature review focuses on using inсеntivеs for improving trеаtmеnt cоmрliаnсе in adоlеsсеnts with chronic conditions. Methods Identification of studies Peer-reviewed publications on incentives and treatment compliance were searched using CINAHL, Medline and PsycINFO electronic databases through Ebsco. All searches were limited to peer-reviewed studies published in English that matched Medical Subject Headings terms (MeSH) terms and keywords across three areas: incentives, compliance and chronic conditions. The following terms were used, seeking matches in the titles, abstracts and descriptors. Incentive keywords included the following: reward, motivation, token economy, incentives and behavioural economics. Compliance keywords included: patient compliance, medication adherence and non-adherence. Chronic conditions keywords included: chronic disease, chronic condition and long term care. To ensure all relevant articles were captured, the most common chronic conditions affecting young adults were additionally searched: type 1 diabetes, asthma, cystic fibrosis, juvenile arthritis and epilepsy. The search terms were combined using Boolean operators OR or AND as appropriate and did not include restrictions on publication date or study design. Inclusion criteria Article titles and abstracts were screened for relevance to the topic of the review. If the title or abstract suggested that the article might be relevant the article was retrieved. Furthermore, the inclusion criteria required that the studies include participants with a mean age less than 18 years. Relevant articles, including reviews, were hand-searched for additional references. Exclusion criteria Studies that were non-English publications, editorials, letters, comments and conference or congress abstracts were excluded. Studies that did not precisely describe the incentives or in which the incentives were not delivered by the study team or a service provider were excluded. Studies not involving chronic conditions i.e. vaccinations, communicable diseases and were behaviour focused were excluded. Also, any studies that featured incentives as part of a multifaceted approach to promoting medication adherence, that did not specifically evaluate the role of incentives in the success of the intervention were excluded. Finally studies that did not examine the relationship between incentives and compliance were excluded. A flow diagram detailing study selection is depicted in Fig 1. The initial search resulted in 1479 records. After removal of duplicates and redundant titles, 532 abstracts were reviewed. During the abstract review process, 519 articles were excluded because they did not meet the inclusion criteria and/or met the exclusion criteria. Of the 13 remaining manuscripts, further inspection resulted in exclusion of an additional 7. A final list of 6 titles to be included in the present review was created. Table 1 summarises the characteristics of the studies that were included in the review. A Review of Literature This section will explore past academic studies on using incentives for improving treatment compliance in adolescents with chronic conditions. According to Gabr & Shams (2015), poor treatment adherence is common among adolescents with chronic conditions. Martin et.al, (2005) adds that adherence to treatment helps to improve patient’s outcomes and also reduces the cost of care. Chronic diseases changes a patient’s’ way of life because they requires constant adaptation. According to Croll (2005), chronicity among adolescents reduces their physical abilities, changes their physical appearance and changes their life’s prospects. Effective treatment of chronic illness requires behavioral change on adolescents. However, most adolescents find it hard to comply with some of the demands, including visiting health care givers regularly, following scheduled daily medications, monitoring their sugar levels among others. Severe asthma attacks, acute pains, cardiac arrests, immobility, and unpredictable situations present greater challenges on adolescents. Various studies on compliance in adolescents with chronic illnesses reveal that 50% of adolescents do not adhere to treatment recommendations. According to Currie (2012), it is vital to understand the various forms of treatment noncompliance. An awareness of these forms of noncompliance enables the healthcare professionals to bolster compliance rates among patients. The following are the common forms of treatment noncompliance in adolescents with chronic conditions: self determination, improper dosage due to lack of clear instructions, missed doses, using wrong medications among others. According to Mattei (2012), missed doses and failure to take medications at the prescribed time are the most common forms of treatment non compliance in adolescents with chronic conditions. Researchers among them Volpp et.al (2009), have found out that the use of monetary rewards is imperative for adolescent patients’ compliance. According to Volpp et.al (2009), incentives should be provided according to patients’ special interests or needs. For instance, if the nursing staff knows that an adolescent is facing transportation problems, he or she may offer bus fare or tokens as an incentive. If the adolescent is not facing transportation problems, the healthcare professional should offer other enablers and incentives that are needed. The nursing staff should strive to learn as much as possible about the adolescents’ patients in order to identify their unique needs, and in turn, motivate them to comply with their treatments. In addition, the nursing staff must establish good relationships with the patients in order to better motivate them. Researchers argue that incentives should be provided as soon as medication starts (Volpp et.al, 2009). Dinwiddie and Muller (2002), in their well researched article, stated that healthcare providers can obtain incentives from various sources, including the state, community organizations, volunteers, business organizations among others. The Australian Government should play its rightful role of providing healthcare professionals with resources so that they can increase awareness on the need to comply with treatment. Research reveals that offering support to healthcare specialists through, for instance, trainings and educational materials, motivates them to provide adolescents with quality health care services, resulting to high rates of treatment compliance (Seys, 2013). The Australian Government can incentivize adolescents with chronic conditions to adhere to treatment by enhancing peer-to-peer relationships. According to Centers for Medicare and Medicaid Services, 2014), the behavior of adolescents (especially older ones) is largely influenced by their peers. Therefore, the government should work closely with key partners such as learning institutions and Federal Qualified Health Centers to enhance treatment compliance in adolescents with chronic conditions. In this case, the government should use the partners as peer educators, and in turn, reward them for their services. Research indicates that adolescents believe that the peer educators are a valuable source compared to adult health educators. This is because they provide adolescents –friendly care, thereby making them to seek medical care willingly and comfortably (Centers for Medicare and Medicaid Services, 2014). Nursing is one of the few professions that demand responsibility to act in the public interest. In this light, nursing professionals are not restricted to only satisfying needs of a particular organization or individual, but also work in the public interest. It is highly imperative that professionals adhere to stipulated ethics as a guide to achieve desired objectives. Normally, using financial incentives for improving compliance in adolescents with chronic conditions presents ethical problems (Szmukler, 2013). According to Staubus (2005), the word ‘ethics’ imbibes community culture and individual behavior within itself. Individuals may hold different opinions on a similar subject because what is perceived as right by one person may be wrong to the other. This differing perspective brings the essence of ethics. Ethics is defined as moral principles that guide conduct of individuals notwithstanding their differing opinions. Ethical conduct is guided by the course of action taken after thoughtful consideration of the way some actions could impact the larger society and other stakeholders. Putting this into consideration, a health profession who uses financial incentives to improve treatment compliance in adolescents with chronic conditions may be viewed as not respecting the fundamental values in our society. Thus, the treatment offered by the nursing staff could be regarded as a commodity rather than something that enhances the quality of life of the patients. Therefore, the nursing profession is forced to choose among alternatives in case a conflict of significant value is present. In this case, the nursing staff aims at achieving treatment compliance, and subsequently enhancing the quality of life of the patient. Discussion and Conclusion Statistics reveals that incidences and prevalence of chronic conditions among adolescents in Australia is rising. By 2020, the chronic conditions will become a major cause of death among adolescents. Chronic conditions in Australia contribute to mortality and economic costs. Strict adherence to medication is the key to positive health outcomes for adolescents with chronic diseases. Adolescents with chronic conditions experience great changes in their lives, including social, biological and physical. Adolescent stage is, therefore, a demanding and tumultuous period for both the adolescent patients and their loved ones. Complexities in adolscents’ lifestyles hinder them from achieving normal goals of teenagers. According to the above review, most adolescents with chronic conditions do not adhere to medications, and this leads to therapeutic failure. In addition, non adherence poses a greater challenge to healthcare professionals and social scientists. In order to achieve adherence to treatment amongst adolescents with chronic diseases, the nursing staff should use incentives such as monetary rewards, verbal praise and special privileges. Incentives have been found out to be effective, especially for improving treatment compliance in adolescents with chronic conditions. Financial incentive promotes treatment compliance better than non financial methods. For example, a small 6AUD incentive for adolescents with chronic conditions is more effective than other methods such as peer support. According to studies, just offering incentives is not enough. Thus, adolescents with chronic conditions must agree to comply with the treatment. The nursing staff must, therefore, play their rightful role of facilitating adolescent patients with chronic conditions to participate in taking their medicine or complying with their clinic appointments. Improving compliance treatment is a critical determinant of long-term health outcome in adolescents with chronic diseases. Non-compliance to treatment may result to drug resistance. According to some scholars, paying adolescents with chronic conditions to comply with treatment is a short term measure. Opinions on the use of incentives to change behavior vary, with some scholars arguing that rewarding adolescents to comply with treatment amounts to bribery. As noted earlier, an adolescent with chronic conditions faces various forms of social marginalization. Therefore, the nursing should exercise caution when using financial incentives to improve treatment compliance. In this regard, the nursing profession must aim at empowering the patient with chronic conditions, and not undermining him or her. To improve treatment compliance in adolescents with chronic conditions, health professionals must design and assess pragmatic strategies that adolescent patients are willing to adopt. The Australian healthcare system is regarded as one of the best in the world. However, the rate of treatment compliance in adolescents with chronic conditions is lower compared to other industrialized nations like the UK. The main reason for noncompliance is lack of incentives. Though several studies about treatment compliance exist, little effort has gone into studying the use of financial incentives to improve treatment compliance in adolescents with chronic conditions. Most of the theoretical and empirical research has never discussed the context of incentive-based treatment compliance. This oversight exists despite the imperative role the incentives play in improving treatment compliance in adolescents with chronic conditions. An assessment of the use of incentives for improving treatment compliance in adolescents with chronic conditions is, therefore, overdue. References ABS. (2014). Australian Bureau of Statistics. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/web+pages/statistics Ardies, C.M. (2014). Diet, Exercise, and Chronic Disease: The Biological Basis of Prevention. London: CRC Press. Centers for Medicare and Medicaid Services. (2014). Paving the Road to Good Health Strategies for Increasing Medicaid Adolescent Well-Care Visits. 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